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Sharif-Nia H, Froelicher ES, Hoseinzadeh E, Kaveh O, Fatehi R, Nowrozi P. Assessing the validity and reliability of the 10-item Persian version of the perceived stress scale in post-surgery patients. Front Psychiatry 2024; 15:1402122. [PMID: 38895033 PMCID: PMC11184503 DOI: 10.3389/fpsyt.2024.1402122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 05/17/2024] [Indexed: 06/21/2024] Open
Abstract
Introduction The 10-item Perceived Stress Scale (PSS-10) is commonly used to measure stress levels in postoperative patients, as research shows that high levels of stress can affect postoperative outcomes. By using the PSS-10, healthcare providers can understand patients' psychological well-being before and after surgery, helping improve recovery and overall health. This study focuses on assessing the reliability and validity of the 10-item Persian version of the PSS (PSS-10-P) in postoperative patients. Methods In a methodological study conducted between October to December 2023, a sample of 400 patients who had undergone surgery in 17 Shahrivar Hospital, Amol, Iran were selected using a convenience sampling method. The PSS-10 scale utilized in the study was translated, and its psychometric properties were evaluated through assessments of construct validity, including exploratory (n = 200) and confirmatory (n = 200) factor analysis, convergent validity, and discriminant validity. Furthermore, the study examined the internal consistency of the scale to ensure its reliability. Results The mean age of the participants was 44.38 (SD= 13.49) years. The results of exploratory factor analysis with Promax rotation extracted two factors accounting for 83.82% of the variance comprising 10 items. After necessary modifications during CFA, the final model was approved. As for reliability, the Cronbach's alpha, CR, and MaxR for all constructs were greater than 0.7, demonstrating good internal consistency and construct reliability. Conclusion According to these results, the Persian version of PSS-10 has a valid structure and acceptable reliability. This scale can be used by health professionals in many ways.
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Affiliation(s)
- Hamid Sharif-Nia
- Psychosomatic Research Center, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Nursing, Amol Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Erika Sivarajan Froelicher
- Department of Physiological Nursing, School of Nursing, and Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Esmail Hoseinzadeh
- Department of Nursing, Faculty of Medical Sciences, Gorgan Branch, Islamic Azad University, Gorgan, Iran
| | - Omolhoda Kaveh
- Department of Nursing, Sari Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Reza Fatehi
- Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | - Poorya Nowrozi
- Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
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Fekih-Romdhane F, Helmy M, Alhuwailah A, Shuwiekh HAM, Naser AY, Maalej E, Obeid S, Cheour M, Hallit S. Mediating effect of depression and acute stress between exposure to Israel-Gaza war media coverage and insomnia: a multinational study from five arab countries. BMC Public Health 2024; 24:1498. [PMID: 38835005 DOI: 10.1186/s12889-024-18996-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/29/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND In the context of persistent wars and conflicts worldwide, the impact of acute, excessive and constant exposure to media coverage of such events on mental health outcomes becomes a serious problem for public health, and requires therefore urgent investigation to inform an effective prevention and management response. The objective of the present study was to test the hypothesis that war-related media exposure is directly and indirectly associated with insomnia through depression and perceived stress among adults from the general population of different Arab countries. METHODS A cross-sectional study was carried-out two weeks after the beginning of Israel-Gaza war on the 7th of October 2023. An anonymous online survey and a snowball sampling method were adopted to collect data. A sample of 2635 general population adults (mean age of 23.98 ± 7.55 years, 73.1% females) took part of this study. RESULTS The results of the mediation analysis showed that, after adjusting over potential confounders, depression and perceived stress fully mediated the association between war media exposure and insomnia; higher war media exposure was significantly associated with higher depression (Beta = 0.13; p < .001) and perceived stress (Beta = 0.07; p < .001), whereas higher depression (Beta = 0.43; p < .001) and perceived stress (Beta = 0.31; p < .001) were significantly associated with higher insomnia. It is of note that war media exposure was not significantly and directly associated with insomnia (Beta = - 0.01; p = .178 and Beta = 0.02; p = .098 respectively). CONCLUSION The present study is the first to provide evidence that more time spent viewing the horrors of war is significantly associated with insomnia. In addition, symptoms of stress and depression were present as early as two weeks following the beginning of the war, and played a significant role in mediating the association between war media coverage and insomnia. These findings suggest that timely screening for, and management of depression and stress symptoms in clinical and preventive programs might be beneficial for community adults who have been heavily and indirectly exposed to war through media, and present with insomnia.
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Affiliation(s)
- Feten Fekih-Romdhane
- Faculty of Medicine of Tunis, Tunis Al Manar University, Tunis, Tunisia.
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry Ibn Omrane, Razi Hospital, Tunis, Tunisia.
| | - Mai Helmy
- Menoufia University, Shebin El-Kom, Egypt
- Psychology department, College of education, Sultan Qaboos University, Muscat, Oman
| | | | | | - Abdallah Y Naser
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, faculty of pharmacy, Isra University, Amman, Jordan
| | - Emna Maalej
- Faculty of Medicine of Tunis, Tunis Al Manar University, Tunis, Tunisia
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry Ibn Omrane, Razi Hospital, Tunis, Tunisia
| | - Sahar Obeid
- School of Arts and Sciences, Social and Education Sciences Department, Lebanese American University, Jbeil, Lebanon
| | - Majda Cheour
- Faculty of Medicine of Tunis, Tunis Al Manar University, Tunis, Tunisia
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry Ibn Omrane, Razi Hospital, Tunis, Tunisia
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon.
- Psychology Department, College of Humanities, Effat University, Jeddah, 21478, Saudi Arabia.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
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Pintro K, Sanchez SE, Rondon MB, Gelaye B. Fourteen-item perceived stress scale assessment using item response theory among pregnant women. Scand J Psychol 2024; 65:443-451. [PMID: 38123342 PMCID: PMC11088525 DOI: 10.1111/sjop.12993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 11/19/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023]
Abstract
The current study aimed to assess the psychometric properties of the Spanish language version of the 14-item Perceived Stress Scale (PSS-S) in a population of pregnant women who speak Spanish in Peru using item response theory (IRT). Our study consisted of 5,435 pregnant women who participated in the Pregnancy Outcomes Maternal and Infant Study (PrOMIS) cohort in Peru. Exploratory and confirmatory factor analyses were conducted to determine dimensionality of the scale in this population, and item response theory was conducted to determine the applicability of the PSS. The PSS consisted of a 2-factor questionnaire measuring perceived stress and coping capacity accounting for 77% of variability. The IRT analysis showed differences in item difficulty and discrimination. Item difficulty represents the level of the latent construct where 50% of respondents endorse a particular response, and item discrimination determines the rate of change of the probability of endorsing an item for differing ability levels. For the first factor, perceived stress, item 12 was the least difficult and item 2 was the most difficult. For the second factor, coping capacity, item 9 was the least difficult and item 6 was the most difficult. The Spanish version of the 14-item PSS can be a useful assessment tool for perceived stress, but more IRT should be done to delve further into the psychometric properties of the questionnaire to inform clinicians and policy makers more appropriately.
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Affiliation(s)
- Kedie Pintro
- Department of Epidemiology, Harvard T. H. Chan School of Public Health
| | - Sixto E. Sanchez
- Universidad de San Martin de Porres, Facultad de Medicina Humana, Instituto de Investigacion, Lima, Peru
| | - Marta B. Rondon
- Department of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Bizu Gelaye
- Department of Epidemiology, Harvard T. H. Chan School of Public Health
- The Chester M. Pierce, M.D. Division of Global Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Ramadan OME, Alruwaili MM, Alruwaili AN, Elsharkawy NB, Abdelaziz EM, El Badawy Ezzat RES, El-Nasr EMS. Digital Dilemma of Cyberbullying Victimization among High School Students: Prevalence, Risk Factors, and Associations with Stress and Mental Well-Being. CHILDREN (BASEL, SWITZERLAND) 2024; 11:634. [PMID: 38929214 PMCID: PMC11202024 DOI: 10.3390/children11060634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 05/17/2024] [Accepted: 05/22/2024] [Indexed: 06/28/2024]
Abstract
Cyberbullying has emerged as a pervasive problem among high school students, with potentially severe consequences for their mental well-being. This study aimed to investigate the prevalence, risk factors, and associations of cyberbullying with stress and mental well-being among high school students in Zagazig, Egypt. A cross-sectional study was conducted among 562 high school students using a random sampling technique. The data were collected using a self-administered questionnaire that included the Cyberbullying Scale, Perceived Stress Scale (PSS-10), and General Health Questionnaire (GHQ-12). Descriptive statistics, independent samples t-tests, multiple regression, mediation, and logistic regression analyses were employed for data analysis. The prevalence of cyberbullying victimization was 38.3%, with 20.6% exposed to two or three cyberbullying behaviors and 4.1% exposed to four or more. Female students, those under 18 years old, those with lower educational achievement, and those with higher daily internet use were more likely to experience cyberbullying. Cyberbullied students reported significantly higher levels of perceived stress and poorer mental well-being compared to non-cyberbullied students. Perceived stress likely mediated the relationship between cyberbullying victimization and general psychological health. Cyberbullying is a significant problem among high school students in Zagazig, Egypt, with detrimental effects on their stress levels and mental well-being. Targeted interventions and prevention strategies are needed to address cyberbullying and promote the well-being of adolescents in the digital age.
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Affiliation(s)
| | - Majed Mowanes Alruwaili
- College of Nursing, Jouf University, Sakaka 72388, Saudi Arabia; (O.M.E.R.); (A.N.A.); (N.B.E.); (E.M.A.)
| | - Abeer Nuwayfi Alruwaili
- College of Nursing, Jouf University, Sakaka 72388, Saudi Arabia; (O.M.E.R.); (A.N.A.); (N.B.E.); (E.M.A.)
| | - Nadia Bassuoni Elsharkawy
- College of Nursing, Jouf University, Sakaka 72388, Saudi Arabia; (O.M.E.R.); (A.N.A.); (N.B.E.); (E.M.A.)
- Maternal and Newborn Health Nursing Department, Faculty of Nursing, Cairo University, Cairo 11562, Egypt
| | - Enas Mahrous Abdelaziz
- College of Nursing, Jouf University, Sakaka 72388, Saudi Arabia; (O.M.E.R.); (A.N.A.); (N.B.E.); (E.M.A.)
- Psychiatric Mental Health Nursing Department, Faculty of Nursing, Cairo University, Cairo 11562, Egypt
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Murshidi R, Hammouri M, Al-Ani A, Kitaneh R, Al-Soleiti M, Al Ta'ani Z, Sweis S, Halasa Z, Fashho E, Arafah M, Almaani N, Abdallat M, Al-Dar'awi F, Kittaneh E, Jaber B, Almudallal F, Smadi Z. Investigating the prevalence of body dysmorphic disorder among Jordanian adults with dermatologic and cosmetic concerns: a case-control study. Sci Rep 2024; 14:5993. [PMID: 38472284 PMCID: PMC10933333 DOI: 10.1038/s41598-024-56315-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/05/2024] [Indexed: 03/14/2024] Open
Abstract
Body Dysmorphic Disorder (BDD) is an underexplored psychiatric condition in Middle Eastern countries, particularly in patients with dermatologic concerns, where alterations in appearance may elevate the risk of BDD. We studied patients at Jordan University Hospital's general dermatology and cosmetic clinics from July to September 2022, comparing them to healthy controls. Patients with dermatologic conditions were evaluated per the International Classification of Diseases (ICD-10) criteria by trained dermatologists. All participants completed the Dysmorphic Concerns Questionnaire (DCQ), Perceived Stress Scale, Patient Health Questionnaire-2, General Anxiety Disorder Assessment tool-2. We assessed BDD prevalence using four DCQ cutoffs: 9, 11, 14, and 17, reporting effect sizes as odds ratios (OR). Our study involved 1500 participants, with an average age of 29.3 (± 14.8) years and a female-to-male ratio of 3.15-to-1. At the 9, 11, 14, and 17 DCQ cutoffs, BDD prevalence was 78.2%, 54.2%, 26.5%, and 11.7%, respectively. Patients with dermatologic concerns were more likely to exhibit clinical BDD symptoms than controls at the 11-cutoff (OR: 1.26; 95% CI 1.01-1.58; p < 0.05). Conversely, those with cosmetic concerns were more prone to clinical BDD than controls at cutoffs 9 (OR: 2.26; 95% CI 1.28-3.97; p < 0.05) and 11 (OR: 1.50; 95% CI 1.03-2.20; p < 0.05). Our logistic regression revealed consistent associations between higher DCQ scores and elevated anxiety, depression, perceived skin disease-related stigma, and reduced quality of life (p < 0.05). In conclusion, patients with dermatologic issues and those seeking cosmetic procedures are at significant risk of developing BDD, necessitating proactive screening and referrals for specialized care by dermatologists due to the associated psychological distress and unproductive consultations. Providing specialized training for healthcare professionals to establish an integrated care approach to address the needs of patients with BDD should be the focus of future research projects.
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Affiliation(s)
- Rand Murshidi
- Department of Dermatology, School of Medicine, The University of Jordan, Amman, Jordan
| | | | - Abdallah Al-Ani
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | - Razi Kitaneh
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06519, USA
- Clinical Neuroscience Research Unit, Connecticut Mental Health Center, New Haven, CT, 06519, USA
| | | | - Zain Al Ta'ani
- Department of Dermatology, School of Medicine, The University of Jordan, Amman, Jordan
| | - Sami Sweis
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Zeina Halasa
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Eva Fashho
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Malak Arafah
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Noor Almaani
- Department of Dermatology, School of Medicine, The University of Jordan, Amman, Jordan
| | - Mahmoud Abdallat
- Department of Neurosurgery, School of Medicine, The University of Jordan, Amman, Jordan
| | | | - Eman Kittaneh
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Besan Jaber
- School of Medicine, The University of Jordan, Amman, Jordan
| | | | - Zina Smadi
- School of Medicine, The University of Jordan, Amman, Jordan
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Almutairi AF, Hamdan NA, Altheyabi S, Alsaeed EA, Alammari FS, BaniMustafa A. The Prevalence and Associated Factors of Occupational Stress in Healthcare Providers in Saudi Arabia. Int J Gen Med 2024; 17:809-816. [PMID: 38476624 PMCID: PMC10929258 DOI: 10.2147/ijgm.s446410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 01/31/2024] [Indexed: 03/14/2024] Open
Abstract
Background Occupational stress is a negative physical and emotional response to job requirements, which might be caused by various factors that can harm the emotional and physical well-being of the employee. We aimed to investigate the factors and conditions associated with occupational stress. Study Design The study was cross-sectional, conducted with the Perceived Stress Scale ten item version. Results The majority of the participants reported moderate stress 223 (71%) and a small proportion (n=38, 12.2%) a high stress level. Several factors associated with higher risk of stress level for example being single were associated with higher risk of stress level in 135 (74.6%), moderate and high stress level was also reported in the group without enough income, 96 (75%) and 20 (15.6%), respectively. Conclusion A group of sociodemographic factors were consistently associated with occupational stress, including gender, income, comorbidity and marital status. However, some factors remained complex and multifaceted. Recommendation It is important to focus on reducing stress levels for all employees, regardless of their work experience or income. To prevent losing control of the healthcare worker's stress and to prevent an escalation to anxiety or depression, stress-management programs are necessary, specifically for those who are experiencing high stress levels.
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Affiliation(s)
- Adel F Almutairi
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | | | - Saud Altheyabi
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | | | - Faisal S Alammari
- College of Dentistry, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Ala’a BaniMustafa
- King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
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Yılmaz Koğar E, Koğar H. A systematic review and meta-analytic confirmatory factor analysis of the perceived stress scale (PSS-10 and PSS-14). Stress Health 2024; 40:e3285. [PMID: 37341705 DOI: 10.1002/smi.3285] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/16/2023] [Accepted: 06/11/2023] [Indexed: 06/22/2023]
Abstract
Stress is defined as a person's interaction with their environment that is thought to threaten or affect an individual's potential, resources, and well-being. The most popular instrument to assess perceived stress is the Perceived Stress Scale (PSS). Therefore, making a systematic review of studies testing the internal structure of PSS and conducting a Meta-Analytic Confirmatory Factor Analysis (MACFA) on the database created with the information obtained from these studies are the aims of this research. A total of 76 samples from 57 unique studies were included in this database using various inclusion criteria (total N for PSS-14 = 28,632, for PSS-10 = 46,053). The correlated two-factor model for PSS was confirmed by MACFA performed on the pooled correlation matrix generated by the random effects meta-analysis. Findings of dimensionality analyses, factor loadings, omega values, and measurement invariance showed that the model that best explained the factor structure of PSS was the correlated two-factor model. The strict measurement invariance of the PSS was achieved across age and clinical status, and the internal consistency was high according to the omega values. Several recommendations moving forward are discussed.
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Affiliation(s)
- Esin Yılmaz Koğar
- Faculty of Education, Niğde Ömer Halisdemir University, Niğde, Turkey
| | - Hakan Koğar
- Faculty of Education, Akdeniz University, Antalya, Turkey
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Pedersen HS, Christensen KS, Prior A, Christensen KB. The dimensionality of the Perceived Stress Scale: The presence of opposing items is a source of measurement error. J Affect Disord 2024; 344:485-494. [PMID: 37852582 DOI: 10.1016/j.jad.2023.10.109] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/26/2023] [Accepted: 10/15/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION The Perceived Stress Scale (PSS) is a widely recognized patient-reported outcome measure designed to assess an individual's level of perceived stress. The PSS consists of ten items, with six items phrased negatively and four phrased positively. Most studies have found that the PSS consists of two dimensions, with negative and positive items forming separate dimensions. However, some studies suggest a one-dimensional construct. OBJECTIVE We aimed to investigate the dimensionality of the PSS and the impact of wording effects on the measurement properties of the scale. METHODS We tested a modified version of the PSS (mPSS), with negative wording of all items. In a Danish sample, respondents were randomized to answer the PSS or the mPSS. We used confirmative factor analysis and Rasch analysis to assess the validity and reliability of the two versions. The proportion of person misfit was also evaluated. RESULTS A total of 326 respondents completed the PSS, whereas 306 completed the mPSS. For the PSS, a two-factor model fitted the data best, and the first positively formulated item showed under-discrimination (Rasch model item fit rejected). The mPSS had higher measurement precision than the PSS, but evidence of local dependence was seen for both versions. Fewer respondents gave improbable responses to the mPSS compared to the PSS. LIMITATIONS Data comes from three different respondent samples. CONCLUSION The PSS was deemed essentially unidimensional, with the extra variance being attributed to the reversed items. To reduce response bias, clinicians and researchers may apply the mPSS.
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Affiliation(s)
- Henrik Schou Pedersen
- Research Unit for General Practice, Aarhus, Denmark; Department of Public Health, Aarhus University, Aarhus, Denmark.
| | - Kaj Sparle Christensen
- Research Unit for General Practice, Aarhus, Denmark; Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Anders Prior
- Research Unit for General Practice, Aarhus, Denmark
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Baklola M, Terra M, Badr A, Fahmy FM, Elshabrawy E, Hawas Y, Abdel-Hady D, El-Gilany AH. Prevalence of gastro-oesophageal reflux disease, and its associated risk factors among medical students: a nation-based cross-sectional study. BMC Gastroenterol 2023; 23:269. [PMID: 37550667 PMCID: PMC10405472 DOI: 10.1186/s12876-023-02899-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 07/21/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) is a common digestive problem in adults particularly medical students, who are one of the most vulnerable groups. Many variables, including lifestyle changes and psychological stress, increase the prevalence of GERD among undergraduate medical students. Therefore, this study aims to assess the prevalence, and risk factors of GERD, and its relationship with perceived stress among medical students in Egypt. METHODS In November and December of 2022, a cross-sectional descriptive study with an analytical component was carried out among medical students from six different universities. An online self-reported questionnaire was used to collect data. The questionnaire included data on sociodemographic characteristics, risk factors, lifestyle, the Arabic version of GerdQ, and the Arabic version of Cohen's Perceived Stress Scale (PSS). RESULTS The questionnaire was filled out by 964 medical students, the majority of whom were female (64%). Overall, 17.1% of participants reported symptoms of GERD. Logistic regression showed that smoking, high perceived stress, and a family history of GERD were the independent predictors of having GERD symptoms, with odds ratios of 4.1, 3.9, and 2.2, respectively. CONCLUSION GERD is a frequent condition among Egyptian medical students, affecting around one-fifth of them. In the fight against GERD, university-based smoking cessation and stress management programs may be influential.
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Affiliation(s)
- Mohamed Baklola
- Faculty of Medicine, Mansoura University, 60El-Gomhoria Street, Mansoura, 35516, Egypt.
| | - Mohamed Terra
- Faculty of Medicine, Mansoura University, 60El-Gomhoria Street, Mansoura, 35516, Egypt
| | - Amr Badr
- Cardiology Department, Benha Teaching Hospital, Banha, Egypt
| | - Fayrouz Mohamed Fahmy
- Faculty of Medicine, Mansoura University, 60El-Gomhoria Street, Mansoura, 35516, Egypt
| | | | - Yousef Hawas
- Faculty of Medicine, Tanta University, Gharbeya, Egypt
| | - Doaa Abdel-Hady
- Public Health and Community Medicine Department, Faculty of Medicine, Mansoura University, 60El- Gomhoria Street, Mansoura, 35516, Egypt
| | - Abdel-Hady El-Gilany
- Public Health and Community Medicine Department, Faculty of Medicine, Mansoura University, 60El- Gomhoria Street, Mansoura, 35516, Egypt
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Wang Y, Jia Q, Wang H, Zou K, Li L, Yu B, Wang L, Wang Y. Revised Chinese resident health literacy scale for the older adults in China: simplified version and initial validity testing. Front Public Health 2023; 11:1147862. [PMID: 37265518 PMCID: PMC10231683 DOI: 10.3389/fpubh.2023.1147862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/10/2023] [Indexed: 06/03/2023] Open
Abstract
Objective This study aimed to develop a short version of the Chinese Resident Health Literacy Scale focused on older adults in China, and further assess the reliability and validity of this short version. Methods The data was from a cross-sectional community-based older adults health survey conducted in 2020. The total of 5,829 older adults were randomly divided into two parts using for the simplification and assessment of the scale, respectively. Item Response Theory (IRT) and Differential Item Functioning (DIF) were used for item analysis and scale simplification. Cronbach's alpha and McDonald's omega were used to assess the reliability and three factors Confirmatory Factor Analysis (CFA) was used to assess the validity, which were compared to the original version. Moreover, Multi-group Confirmatory Factor Analysis (MCFA) was used to test the model invariance of the short version across groups of gender, age groups, level of education, and cognitive status. Results The simplified version consisted of 27 items taken from 50 original items, of them 11 items from the dimension of knowledge and attitudes, 9 items from the dimension of behavior and lifestyle, and 7 items from the dimension of health-related skills. The overall Cronbach's alpha and McDonald's omega were both 0.87 (95%CI: 0.86-0.88). The goodness-of-fits of CFA in simplified version were still acceptable in CFI, TLI, GFI, and RMSEA, even improved in CFI, TLI, and GFI compared to those of original version. Also, the model was stable and invariant in MCFA across gender, cognitive status, and educational level groups. Conclusion In this study, we formed a simplified instrument for measuring health literacy focused on older adults in China. This short version might be more suitable for the priority recommendation in extended tracking of the dynamic changes on the levels of health literacy in the whole life cycle in public health settings. Further research might be to identify the cut-off values to distinguish the older adults with different levels of health literacy.
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Psychometric evaluation of the Depression Anxiety Stress Scale 8 among women with chronic non-cancer pelvic pain. Sci Rep 2022; 12:20693. [PMID: 36450770 PMCID: PMC9712382 DOI: 10.1038/s41598-022-15005-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 06/16/2022] [Indexed: 12/05/2022] Open
Abstract
Psychiatric comorbidity and abusive experiences in chronic pelvic pain (CPP) conditions may prolong disease course. This study investigated the psychometrics of the Depression Anxiety Stress Scale 8 (DASS-8) among women with CPP (N = 214, mean age = 33.3 ± 12.4 years). The DASS-8 expressed excellent fit, invariance across age groups and menopausal status, good know-group validity (differentiating women with psychiatric comorbidity from those without comorbidity: U = 2018.0, p = 0.001), discriminant validity (HTMT ratios < 0.85), excellent reliability (alpha = 0.90), adequate predictive and convergent validity indicated by strong correlation with the DASS-21 (r = 0.94) and high values of item-total correlations (r = 0.884 to 0.893). In two-step cluster analysis, the DASS-8 classified women into low- and high-distress clusters (n = 141 and 73), with significantly higher levels of distress, pain severity and duration, and physical symptoms in cluster 2. The DASS-8 positively correlated with pain severity/duration, subjective symptoms of depression/anxiety, experiences of sexual assault, fatigue, headache severity, and collateral physical symptoms (e.g., dizziness, bloating, fatigue etc.) at the same level expressed by the parent scale and the DASS-12, or even greater. Accordingly, distress may represent a target for early identification of psychiatric comorbidity, CPP severity, experiences of sexual assault, and collateral physical complaints. Therefore, the DASS-8 is a useful brief measure, which may detect mental distress symptoms among women with CPP.
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Tsegaye BS, Andegiorgish AK, Amhare AF, Hailu HB. Construct validity and reliability Amharic version of perceived stress scale (PSS-10) among Defense University students. BMC Psychiatry 2022; 22:691. [PMID: 36352366 PMCID: PMC9644475 DOI: 10.1186/s12888-022-04345-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/29/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Perceived stress scale (PSS) is the most widely used tool for assessing stressful life events and its management. However, its validity and Reliability in Ethiopian Amharic language is not assessed. OBJECTIVE To translate the perceived stress scale (version PSS-10) and assess its validity among Defense University students in Bishoftu, Ethiopia. METHOD From March to May 2020, an anonymous, self-managed questionnaire was used to collect the data on 758 undergraduate students of Defense University in Bishoftu, Ethiopia. Exploratory and Confirmatory factor analyses were employed to assess the factor structure and construct validity of Amharic version of the PSS-10. Composite reliability coefficient and Item total correlation were calculated to assess the internal consistency of Amharic version of the PSS-10. RESULT Exploratory factor analysis resulted in a two-dimensional PSS-10 with Eigenvalues of 3.4 and 1.6, which explained 50.7% of the variance. Confirmatory factor analysis indicates a good model fit of the two correlated factors (Comparative fit index (CFI) = 0.96 with root mean square error of approximation (RMSEA) = 0.04[0.03-0.06] and standardize root mean residual (SRMR) = 0.040). The internal consistency of PSS-10 and the Negative factor were in acceptable range, whereas the Positive factor was marginally acceptable (0.77, 0.78, and 0.68) respectively. CONCLUSION The Amharic translated version of PSS-10 was found to be a valid and reliable instrument to measure the perceived stress level among university students.
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Affiliation(s)
| | - Amanuel Kidane Andegiorgish
- grid.43169.390000 0001 0599 1243Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China ,Department of Epidemiology and Biostatistics, Asmara College of Health Sciences, School of Public Health, Asmara, Eritrea
| | | | - Habtamu Belay Hailu
- grid.510433.00000 0004 0456 257XDefence University, College of Health Sciences, Bishoftu, Ethiopia
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Al Hadid LAE, Al Barmawi MA, Alnjadat R, Farajat LA. The impact of stress associated with caring for patients with COVID-19 on career decisions, resilience, and perceived self-efficacy in newly hired nurses in Jordan: A cross-sectional study. Health Sci Rep 2022; 5:e899. [PMID: 36304762 PMCID: PMC9595341 DOI: 10.1002/hsr2.899] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 08/21/2022] [Accepted: 08/24/2022] [Indexed: 11/05/2022] Open
Abstract
Background and Aims The decision to stay in nursing has been challenged by the recent coronavirus disease 2019 (COVID-19) pandemic. New nurses joined the workforce and provided care to patients with COVID-19 although they received limited training, which could have influenced their intention to stay in nursing. We aimed in this study to examine the impact of caring for patients with COVID-19 on career decisions, resilience, and perceived self-efficacy among newly hired nurses in Jordan. It also tested the predictors of intentions to stay among new nurses. Methods This cross-sectional quantitative study was conducted using an online electronic questionnaire form. The sample included newly hired nurses (n = 300) working in public hospitals and providing care to patients with COVID-19 in different levels of acuity units. The perceived stress scale and Connor-Davidson resilience scale 25 were used to measure stress and resilience among nurses. Results The majority chose nursing as their career, but they were not satisfied with the current work conditions or autonomy in decision-making. Many nurses reported having moderate to high work-related stress and low to moderate resilience. Among all variables in this study, financial income predicted mild intention to stay in nursing. Conclusions Nurses expressed the presence of work-related stress and low to moderate levels of resilience. As new nurses, exposure to these stress levels might lead to burnout. Nursing managers should take necessary measures to promote better work conditions and improve resilience to avoid nurses leaving the profession at times when there is a shortage.
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Affiliation(s)
| | | | - Rafi Alnjadat
- Irbid University CollegeAl Balqa' Applied UniversitySaltJordan
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14
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Attia M, Ibrahim FA, Elsady MAE, Khorkhash MK, Rizk MA, Shah J, Amer SA. Cognitive, emotional, physical, and behavioral stress-related symptoms and coping strategies among university students during the third wave of COVID-19 pandemic. Front Psychiatry 2022; 13:933981. [PMID: 36186888 PMCID: PMC9523087 DOI: 10.3389/fpsyt.2022.933981] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background Stress is manifested by different physical, cognitive, emotional, and behavioral stress-related symptoms, and everyone experiences it uniquely. The COVID-19 Pandemic has tremendously affected university students' lives. So, we conducted this study to determine the stress frequency, causes, determinants, and related symptoms involving physical, cognitive, emotional, and behavioral traits and coping strategies among university students in Egypt during the third wave of the COVID-19 pandemic, 2021. Methods Cross-sectional study targeted 1,467 randomly selected undergraduate university students, representing all colleges from 30 universities in Egypt, through a validated self-administrated questionnaire. Results The total stress-related symptom score was statistically significant (p < 0.05), higher among females, married, living on campus, with a (B) GPA, and those who had both organic and psychological disorders. The top 10 prevalent physical symptoms were headaches, chronic fatigue, hair loss, low back pain, neck pain, shoulders and arm pain, ophthalmological symptoms, acne, shakiness of extremities, and palpitations, respectively. The most reported symptoms regarding the cognitive, emotional, and behavioral aspects were anxiety and racing thoughts, moodiness and irritability, and excessive sleeping, respectively. Nine hundred and thirty-seven (63.9%) reported that the COVID-19 pandemic badly affected their lives, either directly or indirectly. The study showed that the prevalence of stress among university students is more than 97%. One thousand and five (68.5%) preferred isolation as a relieving technique. Conclusion Stress and its related physical, cognitive, emotional, and behavioral symptoms are prevalent among university students. Most of the university students who were recruited reported that the COVID-19 pandemic badly affected their lives and used negative ways to deal with stress, like staying alone and sleeping too much. Positive ways to deal with stress, like seeing a therapist or meditating, were less common.
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Affiliation(s)
- Merna Attia
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | | | | | | | - Jaffer Shah
- New York State Department of Health, New York, NY, United States
| | - Samar A. Amer
- Department of Public Health and Community Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
- Member at Royal Colleague of General Practitioners [INT], London, United Kingdom
- Department of Mental Health Primary Care, Nova University, Lisbon, Portugal
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Sharma MK, Hallford DJ, Anand N. Psychometric evaluation of the internet addiction test in India. Asian J Psychiatr 2022; 73:103136. [PMID: 35588630 DOI: 10.1016/j.ajp.2022.103136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/20/2022] [Indexed: 11/30/2022]
Abstract
The Internet Addiction Test is a widely used assessment of symptoms of internet addiction. Although originally proposed as assessing different components of internet addiction, research has been mixed in terms of its factor structure. This study is the first to examine the psychometric properties of the IAT in an Indian population. A large sample (N = 2700) of Indians living in the Southern city of India were recruited door-to-door and completed the IAT and other validity measures. In Study 1, an exploratory factor analysis (n = 1375) indicated a one-factor structure, with 13 items measuring symptoms of internet addiction. This short-form IAT showed construct and convergent validity by correlating with higher daily internet use, higher scores on measures of problematic internet gaming, social media use, and smartphone use, and functional impact. In Study 2, confirmatory factor analysis (n = 1375) indicted this one-factor structure was a good fit to the data, and the correlations with validity measures were replicated. This short-form IAT appears to be valid as a measure of one underlying factor of problematic internet use in young Indian adults.
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Affiliation(s)
- Manoj Kumar Sharma
- Department of Clinical Psychology, SHUT clinic(Service for Healthy Use of Technology), National Institute of Mental Health & Neuro Sciences, Bengaluru, Karnataka, India.
| | - D J Hallford
- School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, 3220 Melbourne, Victoria, Australia.
| | - Nitin Anand
- Department of Clinical Psychology, National Institute of Mental Health & Neuro Sciences, Bengaluru, Karnataka, India.
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Emotional Reaction to the First Dose of COVID-19 Vaccine: Postvaccination Decline in Anxiety and Stress among Anxious Individuals and Increase among Individuals with Normal Prevaccination Anxiety Levels. J Pers Med 2022; 12:jpm12060912. [PMID: 35743695 PMCID: PMC9224616 DOI: 10.3390/jpm12060912] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 05/26/2022] [Accepted: 05/28/2022] [Indexed: 02/07/2023] Open
Abstract
Although vaccination has been adopted by the WHO to limit worldwide transmission of COVID-19, people’s worries about COVID-19 vaccines may suppress their desire for vaccination despite vaccine availability. This study aimed to investigate anxiety and stress symptoms among 250 Jordanians (mean age = 43.18 ± 6.34 years, 72% females) who received their first vaccine dose. The respondents completed the anxiety and stress subscales of the Depression Anxiety and Stress scale 21 (DASS-21) before and after vaccination. The respondents expressed more moderate–severe levels of stress before than after vaccination (20.8% and 13.2%, respectively). Meanwhile, 37.2% and 45.2% of the respondents expressed moderate–severe anxiety before and after vaccination, respectively. Wilcoxon signed-rank test revealed that the drop in the level of stress from before- (median (IQR) = 5 (1–8)) to after vaccination (median (IQR) = 3 (1–7)) was statistically significant (z = −3.81, p = 0.001, r = 0.17) while the increase in anxiety was not. Anxiety significantly dropped postvaccination among individuals experiencing mild to severe anxiety before vaccination. Similarly, stress and anxiety significantly increased among individuals expressing normal anxiety before vaccination (z = −3.57 and −8.24, p values = 0.001, r = 0.16 and 0.37, respectively). Age positively correlated with postvaccination anxiety among respondents with mild prevaccination anxiety, and it negatively correlated with the prevaccination level of stress in the normal-anxiety group. Gender, marital status, respondents’ level of education, and history of COVID-19 infection had no significant correlation with anxiety or stress at either point of measurement. Overcoming their hesitancy to receive COVID-19 vaccines, individuals with normal levels of anxiety experienced a rise in their distress symptoms following immunization. On the contrary, vaccination seemed to desensitize anxious individuals. Policymakers need to formulate a population-specific plan to increase vaccine preparedness and promote psychological well-being over all during the pandemic.
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The Arabic Version of the Impact of Event Scale-Revised: Psychometric Evaluation among Psychiatric Patients and the General Public within the Context of COVID-19 Outbreak and Quarantine as Collective Traumatic Events. J Pers Med 2022; 12:jpm12050681. [PMID: 35629104 PMCID: PMC9144426 DOI: 10.3390/jpm12050681] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/06/2022] [Accepted: 04/19/2022] [Indexed: 11/30/2022] Open
Abstract
The Coronavirus Disease-19 (COVID-19) pandemic has provoked the development of negative emotions in almost all societies since it first broke out in late 2019. The Impact of Event Scale-Revised (IES-R) is widely used to capture emotions, thoughts, and behaviors evoked by traumatic events, including COVID-19 as a collective and persistent traumatic event. However, there is less agreement on the structure of the IES-R, signifying a need for further investigation. This study aimed to evaluate the psychometric properties of the Arabic version of the IES-R among individuals in Saudi quarantine settings, psychiatric patients, and the general public during the COVID-19 outbreak. Exploratory factor analysis revealed that the items of the IES-R present five factors with eigenvalues > 1. Examination of several competing models through confirmatory factor analysis resulted in a best fit for a six-factor structure, which comprises avoidance, intrusion, numbing, hyperarousal, sleep problems, and irritability/dysphoria. Multigroup analysis supported the configural, metric, and scalar invariance of this model across groups of gender, age, and marital status. The IES-R significantly correlated with the Depression Anxiety Stress Scale-8, perceived health status, and perceived vulnerability to COVID-19, denoting good criterion validity. HTMT ratios of all the subscales were below 0.85, denoting good discriminant validity. The values of coefficient alpha in the three samples ranged between 0.90 and 0.93. In path analysis, correlated intrusion and hyperarousal had direct positive effects on avoidance, numbing, sleep, and irritability. Numbing and irritability mediated the indirect effects of intrusion and hyperarousal on sleep and avoidance. This result signifies that cognitive activation is the main factor driving the dynamics underlying the behavioral, emotional, and sleep symptoms of collective COVID-19 trauma. The findings support the robust validity of the Arabic IES-R, indicating it as a sound measure that can be applied to a wide range of traumatic experiences.
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Ali AM, Hendawy AO, Abd Elhay ES, Ali EM, Alkhamees AA, Kunugi H, Hassan NI. The Bergen Facebook Addiction Scale: its psychometric properties and invariance among women with eating disorders. BMC Womens Health 2022; 22:99. [PMID: 35361186 PMCID: PMC8968775 DOI: 10.1186/s12905-022-01677-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 03/15/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Facebook addiction is increasing, giving rise to limited real-life social networks, loneliness, poor work and academic performance, psychopathology, and low well-being. Facebook entails numerous factors that increase the risk for disordered eating attitudes and behaviors (e.g., use time and Facebook activities such as social grooming and photo sharing). This study aimed to evaluate the psychometric properties of the Bergen Facebook Addiction Scale (BFAS) among patients with eating disorders (EDs) given lack of validation of Facebook addiction measures in this population. METHODS A cross-sectional study involving 123 inpatient and outpatient women with EDs (Mean age = 27.3, SD = 10.6, range = 14-59 years) used confirmatory factor analysis (CFA), multigroup CFA, structural equation modeling (SEM), Spearman's rho Spearman's analysis, McDonald's Omega (ω), Cronbach's alpha (α), and item-total correlations to examine the structure, invariance, criterion validity, reliability, and discriminant validity of the BFAS. RESULTS Correlating the residuals of items 2, 3, and 5 resulted in an excellent fit of a one-factor structure of the BFAS (χ2(7) = 8.515, p = .289, CFI = .998, TLI = .996, RMSEA = .042, SRMR = .0099). The BFAS was invariant at the configural, metric, and scalar levels across groups of EDs, age, education, and marital status. High values of ω and α (.96) as well as item-total correlations (.851-.929) indicated excellent reliability and high discrimination index of the BFAS. Criterion validity is noted by strong positive correlation with the Six-item Internet Addiction Test (S-IAT, r = .88) and SEM using the S-IAT to predict the BFAS (χ2(49) = 103.701, p = .001, CFI = .975, TLI = .966, RMSEA = .096, SRMR = .0317).. CONCLUSION The BFAS is a reliable unidimensional measure. Its high discrimination index and invariance across different groups make it useful for detecting Facebook addiction among patients with ED.
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Affiliation(s)
- Amira Mohammed Ali
- Department of Psychiatric Nursing and Mental Health, Faculty of Nursing, Alexandria University, Smouha, Alexandria, 21527 Egypt
| | - Amin Omar Hendawy
- Department of Biological Production, Tokyo University of Agriculture and Technology, Fuchu, Tokyo, 183-8538 Japan
- Department of Animal and Poultry Production, Faculty of Agriculture, Damanhour University, Damanhour, 22516 Egypt
| | - Eman Sameh Abd Elhay
- Psychiatric and Mental Health Nursing Department, Faculty of Nursing, Mansoura University, Mansoura, 30016 Egypt
| | - Esraa Mohammed Ali
- Department of Basic and Educational Sciences, Faculty of Education for Early Childhood, Alexandria University, Mostafa Kamel, Alexandria, 21646 Egypt
| | - Abdulmajeed A. Alkhamees
- Department of Medicine, Unayzah College of Medicine and Medical Sciences, Qassim University, Unayzah, 52571 Al Qassim Saudi Arabia
| | - Hiroshi Kunugi
- Department of Psychiatry, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605 Japan
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo, 187-8502 Japan
| | - Nagia I. Hassan
- Department of Psychiatric Nursing and Mental Health, Faculty of Nursing, Damanhour University, Damanhour, 22511 Egypt
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Ali AM, Hori H, Kim Y, Kunugi H. The Depression Anxiety Stress Scale 8-Items Expresses Robust Psychometric Properties as an Ideal Shorter Version of the Depression Anxiety Stress Scale 21 Among Healthy Respondents From Three Continents. Front Psychol 2022; 13:799769. [PMID: 35496141 PMCID: PMC9044488 DOI: 10.3389/fpsyg.2022.799769] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 03/03/2022] [Indexed: 01/09/2023] Open
Abstract
To examine the cultural limitations and implications in the applicability of the Depression Anxiety Stress Scale 8-items (DASS-8)—a shortened version of the DASS-21 recently introduced in an Arab sample—this study evaluated its psychometric properties, including measurement invariance, among healthy subjects from the United States, Australia, and Ghana. Confirmatory factor analysis revealed good fit of the DASS-8 relative to a 12-item version (DASS-12). Both the DASS-8 and the DASS-12 were invariant at all levels across genders, employment status, and students vs. non-students. The DASS-8/DASS-12 also expressed invariance at the configural and metric levels across all countries, albeit scalar invariance was not maintained due to misspecification of the factor loadings in the Ghanian sample. Mann–Whitney U test revealed significantly lower levels of mental symptomatology on the DASS measures among Ghanian students than in English-speaking respondents (both students and non-students). The DASS-8 expressed excellent internal consistency (coefficient alpha = 0.89), good convergent validity—noted by high values of item-total correlations (r = 0.87 to 0.88), good predictive validity—indicated by significantly strong correlation with the DASS-21 and its subscales (r = 0.95 to 0.80), and adequate discriminant validity—indicated by heterotrait–monotrait ratio of correlations <0.85. The DASS-8 correlated with the Internet Gaming Disorder-9, the Adult attention-deficit/hyperactivity disorder Self-Report Scale, and the Individualism and Collectivism Scale/Culture Orientation Scale at the same level as the DASS-21 and the DASS-12, denoting its adequate criterion validity. The DASS-8 can be used as a brief alternative to the DASS-21 to screen for mental symptomatology in English-speaking and African cultures. However, the same scores on the DASS-8 and the DASS-12 may not always indicate the same level of symptom severity in subjects from different countries. Further inter-cultural evaluations of the DASS-8 are needed.
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Affiliation(s)
- Amira Mohammed Ali
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Psychiatric Nursing and Mental Health, Faculty of Nursing, Alexandria University, Alexandria, Egypt
- *Correspondence: Amira Mohammed Ali,
| | - Hiroaki Hori
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yoshiharu Kim
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Hiroshi Kunugi
- Department of Psychiatry, Teikyo University School of Medicine, Tokyo, Japan
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
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Mohamad O, Al Sabbah H, Smail L, Hermena EW, Al Ghali R. Food Consumption Frequency, Perceived Stress, and Depressive Symptoms Among Female University Students in Dubai, United Arab Emirates. FRONTIERS IN SUSTAINABLE FOOD SYSTEMS 2022. [DOI: 10.3389/fsufs.2022.792631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BackgroundThis study assessed whether perceived stress and depressive symptoms were associated with the frequency of consumption of specific food groups among female university students.MethodsA cross-sectional study was conducted among female university students using a simple random sampling method. The response rate was 97%, with a total number of 385 participants. The associations between stress levels and most/least-consumed food groups, and between depressive symptoms levels and most/least-consumed food groups were assessed. The questionnaire included a 12-item self-administered food frequency questionnaire, Cohen's Perceived Stress Scale, and the Beck Depression Inventory-II. The study was approved by the University Ethical Committee prior to the data collection. One-way Analysis of Variance (ANOVA) and an independent-sample t-test were performed to test the equality of population means across the categories of each independent variable depending on the number of categories of the independent variable.ResultsOverall, this group of female university students fell under the mild mood disturbance category (depressive symptoms) (BDI-II) and had moderate perceived stress (PSS). Perceived stress was associated with more frequent consumption of salad/raw vegetables and cooked vegetables and less frequent consumption of cake/cookies and meat/sausage products (p < 0.05). Additionally, depressive symptoms were associated with less frequent consumption of fresh fruits and increased consumption of fast food/canned food and soft drinks (p < 0.05).ConclusionsThe data showed that stress and depression were associated with different dietary preferences, which is consistent with the distinctions between stress and depression in human behavior. Specifically, the results revealed associations between soft drinks consumption and higher depressive symptoms and between frequent consumption of salad/raw vegetables and cooked vegetables and higher perceived stress among this group of female university students.
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Ali AM, Al-Amer R, Atout M, Ali TS, Mansour AMH, Khatatbeh H, Alkhamees AA, Hendawy AO. The Nine-Item Internet Gaming Disorder Scale (IGDS9-SF): Its Psychometric Properties among Sri Lankan Students and Measurement Invariance across Sri Lanka, Turkey, Australia, and the USA. Healthcare (Basel) 2022; 10:healthcare10030490. [PMID: 35326968 PMCID: PMC8953588 DOI: 10.3390/healthcare10030490] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/04/2022] [Accepted: 03/05/2022] [Indexed: 12/24/2022] Open
Abstract
The prevalence of internet gaming disorders (IGD) is considerably high among youth, especially with the social isolation imposed by the ongoing COVID-19 pandemic. IGD adversely affects mental health, quality of life, and academic performance. The Internet Gaming Disorder Scale (IGDS9-SF) is designed to detect IGD according to DSM-IV diagnostic criteria. However, inconsistent results are reported on its capacity to diagnose IGD evenly across different cultures. To ensure the suitability of the IGDS9-SF as a global measure of IGD, this study examined the psychometric properties of the IGDS9-SF in a sample of Sri Lankan university students (N = 322, mean age = 17.2 ± 0.6, range = 16–18 years, 56.5% males) and evaluated its measurement invariance across samples from Sri Lanka, Turkey, Australia, and the USA. Among Sri Lankan students, a unidimensional structure expressed good fit, invariance across different groups (e.g., gender, ethnicity, and income), adequate criterion validity (strong correlation with motives of internet gaming, daily gaming duration, and sleep quality), and good reliability (alpha = 0.81). Males and online multiplayers expressed higher IGD levels, greater time spent gaming, and more endorsement of gaming motives (e.g., Social and Coping) than females and offline players. Across countries, the IGDS9-SF was invariant at the configural, metric, and scalar levels, although strict invariance was not maintained. The lowest and highest IGD levels were reported among Turkish and American respondents, respectively. In conclusion, the IGDS9-SF can be reliably used to measure IGD among Sri Lankan youth. Because the scale holds scalar invariance across countries, its scores can be used to compare IGD levels in the studied countries.
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Affiliation(s)
- Amira Mohammed Ali
- Department of Psychiatric Nursing and Mental Health, Faculty of Nursing, Alexandria University, Smouha, Alexandria 21527, Egypt;
| | - Rasmieh Al-Amer
- Faculty of Nursing, Isra University, Amman 11953, Jordan;
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW 2751, Australia
| | - Maha Atout
- School of Nursing, Philadelphia University, Amman 19392, Jordan;
| | - Tazeen Saeed Ali
- School of Nursing and Midwifery, Aga Khan University, Karachi 3500, Pakistan;
| | - Ayman M. Hamdan Mansour
- Department of Psychiatric and Mental Health Nursing, School of Nursing, The University of Jordan, Amman 11942, Jordan;
| | - Haitham Khatatbeh
- Faculty of Health Sciences, Doctoral School of Health Sciences, University of Pécs, 7621 Pécs, Hungary;
| | - Abdulmajeed A. Alkhamees
- Department of Medicine, Unayzah College of Medicine and Medical Sciences, Qassim University, Unayzah, Al Qassim 52571, Saudi Arabia
- Correspondence: ; Tel.: +966-06-3800916
| | - Amin Omar Hendawy
- Department of Biological Production, Tokyo University of Agriculture and Technology, Tokyo 183-8509, Japan;
- Department of Animal and Poultry Production, Faculty of Agriculture, Damanhour University, Damanhour 22516, Egypt
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22
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Alanazi ANH, Alanazi RSM, Alanazi EN, Alanazi RM, Rabbani U. Prevalence of Nocturnal Enuresis Among Children and Its Association With the Mental Health of Mothers in Northern Saudi Arabia. Cureus 2022; 14:e22232. [PMID: 35340510 PMCID: PMC8930502 DOI: 10.7759/cureus.22232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 11/23/2022] Open
Abstract
Background Nocturnal enuresis (NE) is troubling for children and their families. This study aims to investigate the prevalence of NE, its associated health problems, and the outcome of the provided management among children aged 6-18 years and to assess the impact of NE on the mental health of mothers in Northern Saudi Arabia. Methodology A retrospective cross-sectional study was conducted in Arar, Northern Saudi Arabia, among children aged 6-18 years old. Data were collected using a structured questionnaire including a Perceived Stress Scale (PSS). Means ± standard deviations (SDs) were used to represent quantitative data, and frequencies and percentages were used to represent qualitative data. Ordinal logistic regression was used to assess the association of NE with perceived stress. Results A total of 420 participants were included in this study. Nocturnal enuresis was reported in 24% of the respondents’ children. Around 51% of the mothers know about the causes of NE. Nocturnal enuresis caused embarrassment and social shame to 71% of the mothers. Two-thirds (66%) of the mothers wake up the child at night for urination. Three-quarters (76%) of the participants reported improvement on decreasing fluid intake before sleeping. Of the mothers, 19% perceived low stress, 78% perceived medium stress, and 3% perceived high stress. NE was associated with a higher risk of stress (adjusted odds ratio (OR): 2.14; 95% confidence interval (CI): 1.05-4.37). Conclusion About a quarter of the children suffer from NE, of which a large proportion of mothers face embarrassment and shame. There was a significant association between NE and a higher level of stress. Mothers of children with NE should be provided with counseling and social support to ensure good mental health.
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Ali AM, Alkhamees AA, Abd Elhay ES, Taha SM, Hendawy AO. COVID-19-Related Psychological Trauma and Psychological Distress Among Community-Dwelling Psychiatric Patients: People Struck by Depression and Sleep Disorders Endure the Greatest Burden. Front Public Health 2022; 9:799812. [PMID: 35071173 PMCID: PMC8777039 DOI: 10.3389/fpubh.2021.799812] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 11/30/2021] [Indexed: 01/09/2023] Open
Abstract
COVID-19 has created a general state of worry and distress, especially among vulnerable groups such as those with psychiatric diagnoses. Worldwide, psychiatric care provision has drastically suffered during the pandemic, with many patients unable to access proper care, which may have implications for increased mental health consequences in patients with psychiatric disorders (e.g., relapse and suicide). This cross-sectional study used structural equation modeling to investigate COVID-19-related trauma and distress among Arab psychiatric population during COVID-19 quarantine. Patients with pre-existing psychiatric disorders (N = 168) completed an online survey that comprised the Depression Anxiety Stress Scale 21 (DASS-21), the Impact of Event Scale-Revised (IES-R), and a questionnaire on COVID-19-related attitudes/perceptions, sources of information, used protective measures, and socio-demographic information. Respondents commonly reported feeling down-hearted/blue, trouble concentrating, along with symptoms of avoidance and rumination related to the pandemic. Patients with depression and sleep disorders expressed higher COVID-19-related trauma than patients with other disorders. Perceived physical health mediated the effect of co-morbid chronic physical disorders on COVID-19 trauma, psychological distress, perceived vulnerability to COVID-19, and perceived likelihood of recovery in case of contracting COVID-19. Perceived physical health and perceived vulnerability to COVID-19 were strong direct predictors of COVID-19-related trauma and psychological distress. Staying at home negatively predicted COVID-19 trauma and exerted an indirect negative effect on psychological distress via COVID-19 trauma. COVID-19 trauma, age, and marital status directly predicted psychological distress, with COVID-19 trauma being the strongest predictor. Educational level, income, having family members working in the medical field, keeping up to date with the news on deaths/infected cases or the development of COVID-19 drugs or vaccines, satisfaction with available information on COVID-19, and using different protective measures were not associated with significant differences in COVID-19 trauma and psychological distress scores. Immuno-psychiatric interventions should be designed to target COVID-19-trauma and distress among younger single patients with perceived poor physical health, especially those diagnosed with depression and sleep disorders.
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Affiliation(s)
- Amira M. Ali
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan,Department of Psychiatric Nursing and Mental Health, Faculty of Nursing, Alexandria University, Alexandria, Egypt
| | - Abdulmajeed A. Alkhamees
- Department of Medicine, College of Medicine and Medical Sciences, Qassim University, Buraydah, Saudi Arabia,*Correspondence: Abdulmajeed A. Alkhamees
| | - Eman S. Abd Elhay
- Department of Psychiatric Nursing and Mental Health, Faculty of Nursing, Mansoura University, Mansoura, Egypt
| | - Samah M. Taha
- Department of Psychiatric Nursing and Mental Health, Faculty of Nursing, Mansoura University, Mansoura, Egypt
| | - Amin O. Hendawy
- Department of Biological Production, Tokyo University of Agriculture and Technology, Tokyo, Japan,Department of Animal and Poultry Production, Faculty of Agriculture, Damanhour University, Damanhour, Egypt
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Perceived stress during the prenatal period: assessing measurement invariance of the Perceived Stress Scale (PSS-10) across cultures and birth parity. Arch Womens Ment Health 2022; 25:633-640. [PMID: 35420323 PMCID: PMC9072510 DOI: 10.1007/s00737-022-01229-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/06/2022] [Indexed: 11/27/2022]
Abstract
Maternal prenatal stress places a substantial burden on mother's mental health. Expectant mothers in low- and middle-income countries (LMICs) have thus far received less attention than mothers in high-income settings. This is particularly problematic, as a range of triggers, such as exposure to traumatic events (e.g. natural disasters, previous pregnancy losses) and adverse life circumstances (e.g. poverty, community violence), put mothers at increased risk of experiencing prenatal stress. The ten-item Perceived Stress Scale (PSS-10) is a widely recognised index of subjective experience of stress that is increasingly used in LMICs. However, evidence for its measurement equivalence across settings is lacking. This study aims to assess measurement invariance of the PSS-10 across eight LMICs and across birth parity. This research was carried out as part of the Evidence for Better Lives Study (EBLS, vrc.crim.cam.ac.uk/vrcresearch/EBLS). The PSS-10 was administered to N = 1,208 expectant mothers from Ghana, Jamaica, Pakistan, the Philippines, Romania, South Africa, Sri Lanka and Vietnam during the third trimester of pregnancy. Confirmatory factor analysis suggested a good model fit of a two-factor model across all sites, with items on experiences of stress loading onto a negative factor and items on perceived coping onto a positive factor. Configural and metric, but not full or partial scalar invariance, were established across all sites. Configural, metric and full scalar invariance could be established across birth parity. On average, first-time mothers reported less stress than mothers who already had children. Our findings indicate that the PSS-10 holds utility in assessing stress across a broad range of culturally diverse settings; however, caution should be taken when comparing mean stress levels across sites.
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Ali AM, Hori H, Kim Y, Kunugi H. Predictors of Nutritional Status, Depression, Internet Addiction, Facebook Addiction, and Tobacco Smoking Among Women With Eating Disorders in Spain. Front Psychiatry 2021; 12:735109. [PMID: 34899416 PMCID: PMC8663168 DOI: 10.3389/fpsyt.2021.735109] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/19/2021] [Indexed: 01/04/2023] Open
Abstract
Eating disorders (EDs) are a complex group of psychiatric conditions that involve dysfunctional eating patterns, nutritional alterations, and other comorbid psychopathologies. Some women with EDs may develop problematic internet use while they attempt to get information on dieting/weight control or get online support from people with similar problems. They may also drift toward tobacco smoking as a method to regulate their weight or to cope with their weight-related dysphoria. The occurrence of these conditions in EDs may prolong disease course and impede recovery. This study used structural equation modeling to investigate nutritional status (noted by body mass index, BMI), depression psychopathology, internet addiction (depicted by the Internet Addiction Test), Facebook addiction (depicted by the Bergen Facebook Addiction Scale), and smoking among 123 Spanish women diagnosed with EDs (mean age = 27.3 ± 10.6 years). History of hospitalization, marital status, age, and the level of education predicted BMI in certain ED groups. BMI did not predict depression, but it predicted internet addiction, Facebook addiction, and smoking in certain ED groups. Depression did not predict BMI, internet/Facebook addition, or smoking in any ED group. Some sociodemographic and clinical variables had indirect effects on depression, internet addiction, and Facebook addiction while age was the only variable expressing a direct effect on all outcome measures. Age, education, and history of prolonged treatment predicted smoking in certain ED patients. The findings signify that a considerable target for interventional strategies addressing nutritional and addictive problems in EDs would be women with high BMI, history of hospitalization, history of prolonged treatment, who are particularly young, single, and less educated. Replication studies in larger samples, which comprise various subtypes of EDs from both genders, are warranted to define the exact interaction among the addressed variables.
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Affiliation(s)
- Amira Mohammed Ali
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Psychiatric Nursing and Mental Health, Faculty of Nursing, Alexandria University, Alexandria, Egypt
| | - Hiroaki Hori
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yoshiharu Kim
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Hiroshi Kunugi
- Department of Psychiatry, Teikyo University School of Medicine, Tokyo, Japan
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
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Ali AM, Hendawy AO, Almarwani AM, Alzahrani N, Ibrahim N, Alkhamees AA, Kunugi H. The Six-Item Version of the Internet Addiction Test: Its Development, Psychometric Properties, and Measurement Invariance among Women with Eating Disorders and Healthy School and University Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12341. [PMID: 34886068 PMCID: PMC8657305 DOI: 10.3390/ijerph182312341] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/17/2021] [Accepted: 11/20/2021] [Indexed: 12/25/2022]
Abstract
Internet addiction (IA) is widespread, comorbid with other conditions, and commonly undetected, which may impede recovery. The Internet Addiction Test (IAT) is widely used to evaluate IA among healthy respondents, with less agreement on its dimensional structure. This study investigated the factor structure, invariance, predictive validity, criterion validity, and reliability of the IAT among Spanish women with eating disorders (EDs, N = 123), Chinese school children (N = 1072), and Malay/Chinese university students (N = 1119). In school children, four factors with eigen values > 1 explained 50.2% of the variance, with several items cross-loading on more than two factors and three items failing to load on any factor. Among 19 tested models, CFA revealed excellent fit of a unidimensional six-item IAT among ED women and university students (χ2(7) = 8.695, 35.038; p = 0.275, 0.001; CFI = 0.998, 981; TLI = 0.996, 0.960; RMSEA = 0.045, 0.060; SRMR = 0.0096, 0.0241). It was perfectly invariant across genders, academic grades, majors, internet use activities, nationalities (Malay vs. Chinese), and Malay/Chinese female university students vs. Spanish women with anorexia nervosa, albeit it was variant at the scalar level in tests involving other EDs, signifying increased tendency for IA in pathological overeating. The six-item IAT correlated with the effects of internet use on academic performance at a greater level than the original IAT (r = -0.106, p < 0.01 vs. r = -0.78, p < 0.05), indicating superior criterion validity. The six-item IAT is a robust and brief measure of IA in healthy and diseased individuals from different cultures.
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Affiliation(s)
- Amira Mohammed Ali
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo 187-8553, Japan
- Department of Psychiatric Nursing and Mental Health, Faculty of Nursing, Alexandria University, Smouha, Alexandria 21527, Egypt
| | - Amin Omar Hendawy
- Department of Biological Production, Tokyo University of Agriculture and Technology, Tokyo 183-8509, Japan;
- Department of Animal and Poultry Production, Faculty of Agriculture, Damanhour University, Damanhour 22516, Egypt
| | - Abdulaziz Mofdy Almarwani
- Department of Psychiatric Nursing, College of Nursing, Taibah University, Janadah Bin Umayyah Road, Tayba, Medina 42353, Saudi Arabia;
| | - Naif Alzahrani
- Department of Medical Surgical Nursing, College of Nursing, Taibah University, Janadah Bin Umayyah Road, Tayba, Medina 42353, Saudi Arabia;
| | - Nashwa Ibrahim
- Department of Psychiatric and Mental Health Nursing, Faculty of Nursing, Mansoura University, Mansoura 35516, Egypt;
| | - Abdulmajeed A. Alkhamees
- Department of Medicine, College of Medicine and Medical Sciences, Qassim University, Al Qassim, Buraydah 52571, Saudi Arabia;
| | - Hiroshi Kunugi
- Department of Psychiatry, School of Medicine, Teikyo University, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan;
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, 4-1-1, Ogawahigashi, Kodaira, Tokyo 187-8502, Japan
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Ali AM, Alkhamees AA, Hori H, Kim Y, Kunugi H. The Depression Anxiety Stress Scale 21: Development and Validation of the Depression Anxiety Stress Scale 8-Item in Psychiatric Patients and the General Public for Easier Mental Health Measurement in a Post COVID-19 World. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10142. [PMID: 34639443 PMCID: PMC8507889 DOI: 10.3390/ijerph181910142] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 01/15/2023]
Abstract
Despite extensive investigations of the Depression Anxiety Stress Scales-21 (DASS-21) since its development in 1995, its factor structure and other psychometric properties still need to be firmly established, with several calls for revising its item structure. Employing confirmatory factor analysis (CFA), this study examined the factor structure of the DASS-21 and five shortened versions of the DASS-21 among psychiatric patients (N = 168) and the general public (N = 992) during the COVID-19 confinement period in Saudi Arabia. Multigroup CFA, Mann Whitney W test, Spearman's correlation, and coefficient alpha were used to examine the shortened versions of the DASS-21 (DASS-13, DASS-12, DASS-9 (two versions), and DASS-8) for invariance across age and gender groups, discriminant validity, predictive validity, item coverage, and internal consistency, respectively. Compared with the DASS-21, all three-factor structures of the shortened versions expressed good fit, with the DASS-8 demonstrating the best fit and highest item loadings on the corresponding factors in both samples (χ2(16, 15) = 16.5, 67.0; p = 0.420, 0.001; CFI = 1.000, 0.998; TLI = 0.999, 0.997; RMSEA = 0.013, 0.059, SRMR = 0.0186, 0.0203). The DASS-8 expressed configural, metric, and scalar invariance across age and gender groups. Its internal consistency was comparable to other versions (α = 0.94). Strong positive correlations of the DASS-8 and its subscales with the DASS-21 and its subscales (r = 0.97 to 0.81) suggest adequate item coverage and good predictive validity of this version. The DASS-8 and its subscales distinguished the clinical sample from the general public at the same level of significance expressed by the DASS-21 and other shortened versions, supporting its discriminant validity. Neither the DASS-21 nor the shortened versions distinguished patients diagnosed with depression and anxiety from each other or from other psychiatric conditions. The DASS-8 represents a valid short version of the DASS-21, which may be useful in research and clinical practice for quick identification of individuals with potential psychopathologies. Diagnosing depression/anxiety disorders may be further confirmed in a next step by clinician-facilitated examinations. Brevity of the DASS-21 would save time and effort used for filling the questionnaire and support comprehensive assessments by allowing the inclusion of more measures on test batteries.
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Affiliation(s)
- Amira Mohammed Ali
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo 187-8553, Japan; (H.H.); (Y.K.)
- Department of Psychiatric Nursing and Mental Health, Faculty of Nursing, Alexandria University, Alexandria 21527, Egypt
| | - Abdulmajeed A. Alkhamees
- Department of Medicine, College of Medicine and Medical Sciences, Qassim University, Buraydah 52571, Al Qassim, Saudi Arabia;
| | - Hiroaki Hori
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo 187-8553, Japan; (H.H.); (Y.K.)
| | - Yoshiharu Kim
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo 187-8553, Japan; (H.H.); (Y.K.)
| | - Hiroshi Kunugi
- Department of Psychiatry, Teikyo University School of Medicine, Tokyo 173-8605, Japan;
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo 187-8502, Japan
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